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133 BELVEDERE ST FENCE/BARR PERM FENCE WALL OR BARRIER PERMIT PERMIT NUMBER } CITY OF ATLANTIC BEACH FNCE19-0015 800 SEMINOLE ROAD ISSUED: 2/8/2019 ATLANTIC BEACH, FL 32233 EXPIRES: 8/7/2019 MUST CALL INSPECTION • • • 1 + 247-5814 BY + PM FOR NEXT DAY • • ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' 1 BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 133 BELVEDERE ST FENCE WALL OR BARRIER FENCE FENCE $200.00 TYPE OF • ZONING: :D • • • GROUP: 170587 0000 SALTAIR SEC 01 COMPANY: ADDRESS: • ADDRESS: TYJEWSKI CHRISTINA R ET 133 BELVEDERE ST ATLANTIC BEACH FL 32233 AL WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. LIST OF . . Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. 1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL Notes: All runoff must remain on-site during construction. 2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City right-of-way. Issued Date: 2/8/2019 1 of 2 FENCE WALL OR BARRIER PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH FNCE19-0015 � = - 800 SEMINOLE ROAD ISSUED: 2/8/2019 ATLANTIC BEACH. FL 32233 EXPIRES: 8/7/2019 3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration,including sod,is required. 4 PUBLIC WORKS FENCING REMOVED INFORMATIONAL Notes: All old fencing must be removed from job site by Contractor. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50 FENCE 455-0000-322-1000 0 $35.00 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $81.50 Issued Date: 2/8/2019 2 of 2 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road �, c Atlantic Beach, Florida 32233-5445 oG/1.)1 Phone(904)247-5826 • Fax(904)247-5845 z Fi Ji �a E-mail: building-dept@coab.us Date routed: City web-site: http://vvww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (�j C— L� C 1�� PC- �f Department review required Yes No ii Applicant: C-Panning &Zoning— Tree minis ra or Project: Co ( {� PuTlic1Nor�s' ublic Uti i i s Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. []Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING - p Reviewed by:#/O�� S Date: � 1 TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. []Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ri.:Ly;y„ City of Atlantic Beach APPLICATION NUMBER pity Building Department (To be assigned by the Building Department.) 800 Seminole Road �� /l Atlantic Beach, Florida 32233-5445 L F) l✓ Phone(904)247-5826• Fax(904)247-5845 Z / n l x! ED) >%' E-mail: building-dept@coab.us Date routed: ( `T City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 � ��]C—LVC tJ�2E Department review required Yes No 10 ii Applicant: ��( �-- i Tree mi ra or Project: Co f t— .tom G u F1ic Wor s_ ublic ti i i s Public Safety Fire Services Review fee $ Dept Signature 4141 Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING q A41 Reviewed :b Z � e: at2' ' Y TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. []Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER �S a � Building Department (To be assigned by the Building Department.) 800 Seminole Road ThECIVE I Atlantic Beach, Florida 32233-5445 ' L l 1 l✓v E-) Phone(904)247-5826 - Fax(904)247-E84iR 0 5 2019 Z j� 9E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: � �� (2j C— LVC_!�E PE ( Department review required Yes No ii Applicant: !� -�L' fanning &Zoning-- Tree A d minis ra or Project: ( 1� �� Pubic works` ublic UtiTi i s Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APP CATION STATUS Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING K PLANNING &ZONING Reviewed bk.- Date: 4! TREE ADMIN. Second Review: []Approved as revised. ❑Denied. []Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Ly;y� City of Atlantic Beach APPLICATION NUMBER jsz Building Department (To be assigned by the Building Department.) 800 Seminole Road f� �l r,r. Atlantic Beach, Florida 32233-5445 l L�, V L1 Phone(904)247-5826 Fax(904)247-5845 / 4- 119 4 I l 9 E-mail: building-dept@coab.us Date routed: Z City web-site: http://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I ��C— LV(--- pt: PIE Department review required Yes No Applicant: t� �� arming &Zonin (� Tree Administrator Project: ( t— .1� C-� u lic Wor ublic i i i Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Q pproved. ❑Denied. ❑Not applicable (Circle one.) Comments: UILDING PLANNING &ZONING Reviewed by: Date: –1 TREE ADMIN. Second Review: ❑Approved as revised. ❑Deni d. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Building Permit Application Updoted10/9/18 J P� City of Atlantic Beach Building Department "ALL INFORMATION V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY OR 9 IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us ['-' ) Q / ED Job Address: t33 (3�lJ•c.l+wC, o. Permit Number: I im t l - 01,.E Legal Description l3 3 6-rAv..-&k&« %fir - _RE# 1 7 Q)S -7,OQC�C Valuation of Work(Replacement Cost)$ Zio Heated/Cooled SF Non-Heated/Cooled • Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial &Residential • If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No • Will trees be removed in association with proposedproject? ❑Yes must submit separate Tree Removal Permit No Describe in detail the type of work to be performed: Florida Product Approval# for multiple products use product approval form Property Owner Information Name G k`s4 i-t#L f �Ck4 R A6t. 'QCT Address 4"A- C City A r+L" 4et, M3e,L. k—L State V�(_zip 321-3 3 Phone kill 06 0A 1 E-Mail c..'Pf_ C-.04- Owner or A ent(If Agent, Power of Attorne or Agency Letter R;City ired) Contractor Information VVa.��p-:— Name of Company ualifying Agent Address State Zip Office Phone J Site Contact Number State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt o Expiration Date Application is hereby made to obtain a per it to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the,standards of all the laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS,POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE Y NOTICE OF COMMENCEMENT. (Signature of Owner or Agent) (Signature of Contractor) Si ned and sworn to(or a fir ed)before me this I day of Signed and sworn to(or affirmed)before m s day of Z , , y L L by �Y'•�., TONI GROL (Si tur f rgnature of Notary) PAY COMMISSION#FF 924951 *: ' • .•`a EXPIRES:October 6,2019 *:•. e; T p10 Wir,Undernriters (''•�,CP ° ]Personally Known O u Identification (:'I rod Identification Type of Identification: �tj `L 2,G, e Z ( Z 3) 0 4-Ty of tification : JLJ6 ' Yfl,Llry, Owner Builder Affidavit "ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: /�^In'e—El(Q -ms- I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING ATA COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. H. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT COAB.US) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: A 4-14K�?c Rt" Owner Name:_ C�PgLR,.. Phone Number: g(3 qte oM Mailing Address: V33 Ciclvca.t v t,f• City: A-h,% 4-L Sit State: (7zip: 3Z')- -33 Notarized Signature of Owner The f oing ins ument was acknowledged before me this day of 20 1 in the State of Florida, County of Signature of Notary Public [ ] Personally Known OR [ ] Produced Identification Type of Identification: �— •_4, TONT GINDLESPERER Updated 10/24/18 n r MY cOMMISSION#FF 9?- 1 ` ' EXPIRES:October 6,2019 !1 Bonded ThruNotary Public Underrd BOUNDARY SURVEY 0 yy - N W 0 �" _ M �'' • 0 O �Z� O 4t: 00 "�.; �• 0 z 100.00' 25.0' 020? Z4 p 4�e4tt- 900 rW I`• O O 39.3' oo, F- yam•"•,••,.1,• � y•�• 0 21.4' 3.2'� �cr, o H o CD m I o • ••�• Lr)' .v ' r• n•••�• 42.5' W 21.4' 3610 .2' o 11 ; p0 O wM ` cq C) fat 1 ° 25.0' 100.00' - o M NWQ _ co [� m �CL ^. WZ ZZZ C7 (j)0m H 04 o 0 l LL.. SURVEY NOTES UORCRFTE-6R1VE CROSSING INTO RNV ON WESTERLY SIDE OF LOT, THERE ARE FENCES NEAR THE BOUNDARY OF THE PROPERTY. t N T o s e Pt 1 F 1 e h o No.8415 rF SURVEYORS CERTIFICATE TARGET k I HEREBY CERTIFY THAT THIS BOUNDARY SURVEYC/l � T� � � ISA TRUE AND CORRECT REPRESENTATION OFA V E1SURVEY PREPARED UNDER MY DIRECTION. �NOT VALID WITHOUT AN AUTHENTICATED ELECTRONICLB#7893 STATE OF SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, ORARAISEDEMBOSSEDSEALANDSIGNATURE- SERVING FLORIDA '�h R o a I °►op Digitally signed by o` h/ a u Kenneth J,.Kenneth J.Osborne 6250 N.MILITARY TRAIL,SUITE 102 e Date:2018.09.10 WEST PALM BEACH,FL 33407 O S b O r n 10:23:17 04'00' PHONE( 0x)22 (SIGNED) STATEWIDE PHONEONE((800)226.4807 KENNETH J OSBORNE STATEWIDE FACSIMILE(800)741-0576 PROFESSIONAL SURVEYOR AND MAPPER#6415 (NOCb13PGE7'E WIT1fODT�AL 1) WEBSITE:httplAargetsurveong.net